Tuesday, May 6, 2008

Notes from the APA Meeting

Here I am at the No Free Lunch booth in the Exhibit Hall of the annual meeting of the American Psychiatric Association. The Pristiq coffee lounge is buzzing with caffeine-seeking psychiatrists a few yards away. Beyond that, a quarter mile of exhibits, small and large, some from drug companies, publishing companies, software companies, and physician placement firms.

We offer a No Free Lunch Pen Amnesty program, in which doctors can exhange their drug company pens for our No Free Lunch pens.

Hundreds of psychiatrists have strolled by, amused and intrigued. Many are skeptical, believing that lunches and pens do not influence their prescribing habits. Others tell stories about having prescribed Invega after the Risperdal rep came by and later wondering why on earth they did so. Another doctor said that, as an intern, he prescribed nothing but Zoloft because the Pfizer rep got to him before the other reps.

These are great discussions, often coming back to the question of "so what?" Are patients actually harmed by drug company gifting? These are difficult questions. My own feeling is that patients want me to make my prescribing decisions based on scientific grounds, and not based on the giving of gifts. I don't need the gifts, and I can get much more reliable information about drugs by reviewing the journals checking internet websites.

Time to sign off--the exhibit hall just closed, and they are turning the lights on and off. More stories later this week!

A universal view from the APA newsroom: very little news to report from the APA. A few impressions for what its worth:

The NIMH -- which has home turf here in D.C. -- is pushing PTSD and related disorders, in addition to Deep Brain Stimulation for Treatment Resistant Depression (with Helen Mayberg, MD).

E. Cameron Ritchie, MD, in "Psychological Effects of War: From the Battlefront to the Home Front and Back Again," was quoted as predicting that suicides among returning Iraq veterans will equal war-time casualties.

A plethora of posters for the atypicals support potential approval for other indications, including depression. Sorry TF, but all the atypicals make strong showings. Overall, the bipolar-dominated programs of the last few years have been transplanted by schizophrenia-dominated symposia under banner heads of Genetics, Chronic Disease Models, and Brain Imaging.

An interesting program put on by a new group titled "Medical Crossfire" is unique enough to warrant mention and might be a new model of things to come.

DSM-V Research Planning is underway and should be making more news but seems to be flying under the radar, which is confusing to me.

Also of note is that there seems to be less industry-sponsored programs, overall, and that firewalls between sponsors and speakers are real. As the chairman of one major dinner told me, "I don't know how XYZ Company will feel after this night is over."

I'm already en route from the meeting. No doubt that DC and others will have more to report from the last few days. -J

TF: two quick questions. One, can you give me an example of a "classic" primary care physician's prescribing mistake? And, two, your comments about comorbid substance abuse is proof positive that the DSM-V needs to address carefully and transparently a new subset of problems that only you and clinicians like you can tell them. I would highly suggest that the DSM-V editors set-up an efficient means of communicating with physicians on the front-lines and not just the usual experts. Hang in there. Peace, j

Dan: Your collaboration with this farce is appalling. 10,000 psychiatrists fly a 1000 miles each way. They learn 4 new ideas. Go home. They have consumed massive carbon, wasted massive time, lost massive income.

They could have received these four ideas by email. You appear to relish in this ecological disaster.

SC: Will we ever get to the point where we can disqualify a meeting of experts because of the accumulated carbon footprints they make? I doubt a Libertarian such as yourself would allow it. That is for each of us to decide.

Stephany: other news reported from the meeting today: Research Finds Possible Link Between Allergies and Suicidality (see http:// brainscienceblogs.com/news-from-the-apa-in-washingto/) and Alcohol Craving in Women, Not Men, More Likely to Be Linked to Depression -- all from reliable Medscape coverage. (nb. no sponsorship associated.)

The most pressing news is still not evident to many of the journalists's covering the meeting; that is the future role of the atypicals. The trend is coming on strong and I can only hope that patient's such as your daughter will be helped in the long term. I am at a loss to throw any weight behind the issue other than to declare with confidence that it is happening. That's all for now. The meeting is closed. Time will tell. Good night all, j

Jim: The irony of the behavior of these appalling libs was for your entertainment only.

The hypocrites quibble about a pen, but devastate the earth.

Naturally, they have every right to do so. But they are self-dealing hypocrites misleading the public by their campaign.

These atypicals really have no name. Nor are companies truly exploiting their strongest benefits. They will be studied by future MBA students in a course called, Historic Business Mistakes. IBM refused the patent offer for the copying machine. IBM gave DOS to Bill Gates. Like that.

Doctors are exploiting their strongest benefits, all off label. Without having to take anyone's word, these companies can look at Verispan data for the standard of care today. They refuse to do that to the detriment of the shareholder.

Thanks for the new update James, all of those topics are worthy of a look. I'm intrigued by the allergy/suicidal connection, as well as the others. I appreciate your added hope for my daughter very much.,Stephany

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I am a psychiatrist in Newburyport, Massachusetts and an Associate Clinical Professor of Psychiatry at Tufts Medical School (but note that the opinions expressed in this blog are not those of Tufts). I graduated from the psychiatric residency at Massachusetts General Hospital in 1995, and am the founder and publisher of three CME newsletters, including The Carlat Psychiatry Report. In March 2012, I left the publishing world to work on conflict of interest issues for The Pew Charitable Trusts, as director of the Pew Prescription Project. I returned to Newburyport and Carlat Publishing in September 2014.